Kremer Heidemarie, Ironson Gail, Schneiderman Neil, Hautzinger Martin
Department of Psychology, University of Miami, Miami, Florida, USA.
AIDS Patient Care STDS. 2006 May;20(5):335-49. doi: 10.1089/apc.2006.20.335.
Knowledge is limited regarding decision-making about antiretroviral treatment (ART) from the patient's perspective. This substudy of a longitudinal study of psychobiologic aspects of long-term survival, conducted in 2003, compares the rationales of HIV-positive individuals (n = 79) deciding to take or not to take ART. Inclusion criteria were HIV/AIDS symptoms, or CD4 nadir less than 350, or viral load greater than 55,000. Those not meeting any criteria for receiving ART (2/2003 U.S. DHHS treatment guidelines) were excluded. Diagnosis was on average 11 years ago; 36% were female, 42% African American, 28% Latino, 24% white, and 6% other. Qualitative content analysis of semistructured interviews identified 10 criteria for the decision to take or not to take ART: CD4/viral load counts (87%), quality of life (85%), knowledge/ beliefs about resistance (66%), mind-body beliefs (65%), adverse effects of ART (59%), easy-to-take regimen (58%), spirituality/worldview (58%), drug resistance (41%), experience of HIV/AIDS symptoms (39%), and preference for complementary/alternative medicine (17%). Participants choosing not to take ART (27%) preferred complementary/alternative medicine (r = 0.43, p = 0.001)1, perceived a better quality of life without ART (r = 0.32, p < 0.004), and weighted avoidance of adverse effects of ART more heavily (r = 0.24, p < 0.030) than participants taking ART (73%). Demographic characteristics related to taking ART were having a partner (r = 0.31, p < 0.008) and having health insurance (r = 0.26, p< 0.040). Decisions to take or not to take ART depend not only on patient medical characteristics, but also on individual beliefs about ART, complementary/alternative medicine, spirituality, and mind-body connection. HIV-positive individuals declining treatment place more weight on alternative medicine, avoiding adverse effects and perceiving a better quality of life through not taking ART.
从患者角度来看，关于抗逆转录病毒治疗（ART）决策的相关知识有限。这项2003年开展的长期生存心理生物学方面纵向研究的子研究，比较了决定接受或不接受ART的HIV阳性个体（n = 79）的理由。纳入标准为出现HIV/AIDS症状，或CD4最低点低于350，或病毒载量高于55,000。不符合任何接受ART标准（2003年美国卫生与公众服务部治疗指南）的个体被排除。诊断平均在11年前；36%为女性，42%为非裔美国人，28%为拉丁裔，24%为白人，6%为其他种族。对半结构化访谈进行的定性内容分析确定了决定接受或不接受ART的10条标准：CD4/病毒载量计数（87%）、生活质量（85%）、关于耐药性的知识/信念（66%）、身心信念（65%）、ART的不良反应（59%）、易于服用的治疗方案（58%）、灵性/世界观（58%）、耐药性（41%）、HIV/AIDS症状体验（39%）以及对补充/替代医学的偏好（17%）。选择不接受ART的参与者（27%）更倾向于补充/替代医学（r = 0.43，p = 0.001），认为不接受ART时生活质量更好（r = 0.32，p < 0.004），并且比接受ART的参与者（73%）更看重避免ART的不良反应（r = 0.24，p < 0.030）。与接受ART相关的人口统计学特征包括有伴侣（r = 0.31，p < 0.008）和拥有医疗保险（r = 0.26，p < 0.040）。接受或不接受ART的决定不仅取决于患者的医学特征，还取决于个体对ART、补充/替代医学、灵性以及身心联系的信念。拒绝治疗的HIV阳性个体更看重替代医学、避免不良反应以及通过不接受ART感知到更好的生活质量。
